Outer Hebrides Alcohol & Drug Partnership Co-ordinating action to prevent and reduce problem drinking and substance use

Transcription

1 Outer Hebrides Alcohol & Drug Partnership Co-ordinating action to prevent and reduce problem drinking and substance use Draft Delivery Plan

2 Contents Foreword p Introduction p ADP Partner Organisations p Summary of key changes to be achieved p National Core Outcomes to be achieved p Local Outcomes to be achieved p Financial Investment p Priority Actions & Interventions to Improve Outcomes p Governance and financial accountability arrangements p Request for National Support p. 35 Appendices: Appendix 1: Models (1 5) to support delivery plan p Appendix 2: Logic Models p Appendix 3: ADP Strategic Models p Contact Details p. 51 2

3 Foreword The Outer Hebrides Alcohol & Drug Partnership (ADP) Delivery Plan has been developed with a focus on action to meet priorities and objectives under the broad headings of Early Years, Early Intervention, Problem Drinkers and Substance Users and Promoting a Healthy Outer Hebrides. The delivery plan aims to ensure that a range of measures are in place to inform the community of the appropriate use of alcohol, to remain vigilant in attempting to reduce drug related harm and to maintain the relatively low levels of drug use in the Outer Hebrides. The Outer Hebrides ADP is embedded into the Community Planning structure, ensuring problems associated with substance use can be dealt with effectively at every level and will consolidate the Outer Hebrides ADP s commitment to the Community Planning process. The purpose of the Community Planning Partnership is to ensure that partners develop and deliver a shared understanding of priorities for their local area, and address these by cutting across boundaries rather than each organisation working in isolation. It is a process of working together for the benefit of local communities, providing better services and improving the lives of local people. Substantial developments have taken place in all areas of ADP responsibility. The Outer Hebrides ADP has developed its strategic priorities to inform its stakeholders and the community of the direction it will take for This direction has been set within and has taken account of government policies for substance use. We have consulted with a wide range of partners and service users in order to determine how the Outer Hebrides should respond to the challenges faced by individuals, families and local communities with respect to alcohol and drugs. The Outer Hebrides ADP remains proactive in tackling issues around drug and alcohol misuse by working with services that will improve the outcomes for individuals, their families and local communities within the Outer Hebrides. Chief Inspector Gordon Macleod Outer Hebrides Alcohol & Drug Partnership Chairman 3

4 1. Introduction The Outer Hebrides ADP strategic priorities have been developed with a focus on action to meet priorities and objectives under the broad headings of: Early years: Children 0-5 affected by substance use Children affected by parental substance use Early intervention: Young people aged 5 25 affected by substance use Families and young people affected by substance use Vulnerable groups Harmful and hazardous drinkers and substance users Problem drinkers and substance users Dependent drinkers and substance users Persistent heavy drinkers and persistent substance users Assist in the promotion of a healthy Outer Hebrides (with our partners) Promote positive attitudes Promote positive choices The Outer Hebrides ADP strategic priorities will focus more on the delivery of outcomes, which will benefit the people of the Outer Hebrides. As detailed in this document, there are clear problems associated with the misuse of alcohol within the Outer Hebrides. Ensuring the provision of accessible and effective services for those in need whilst ensuring we maintain our current low level of drug use will be key to the work of the Outer Hebrides ADP during the life of the ADP strategic priorities. This Delivery Plan is intended to be a flexible working document and seeks to engage the wider community in a knowledgeable and measured response to a problem which in one form or another touches the life of every person in our islands in one way or another. In commending this Delivery Plan to the public and partner organizations we invite all who are interested to work together to make the Outer Hebrides a healthier place to live and work. 4

5 2. ADP Partner Organisations The Outer Hebrides ADP plays a significant role in the local delivery of national addiction strategies to tackle drug and alcohol misuse problems. Members are drawn from a wide range of agencies and groups. As of 1 st June 2012, the Outer Hebrides ADP consists of representatives from: NHS Western Isles Northern Constabulary Comhairle nan Eilean Siar The Third Sector Service users Each partner agency is required to set out clearly and openly, the totality of resources they are directing to the pursuit of alcohol and drug outcomes. The Scottish Government Health Directorate allocates funds directly to NHS Western Isles who are required to work with local partners to identify how resources may be best deployed in line with national and local strategies and need. The Outer Hebrides ADP Partnership Members are as follows: Name Designation Organisation Member of Workgroup/ Subgroup ADP Chair: G MacLeod Chief Inspector Northern Constabulary ADP & Executive Subgroup ADP Vice Chair: G Jamieson Chief Executive NHS Western Isles ADP Members: M Stewart Social and Community Services Comhairle nan Eilean Siar ADP M B Chisholm Children & Families Services Comhairle nan Eilean Siar ADP & Executive Subgroup E Collier Public Health NHS Western Isles ADP & Executive Subgroup I MacKenzie Housing Strategy & Development Comhairle nan Eilean Siar ADP 5

6 M Bremner Member Voluntary Sector ADP & Executive Subgroup Uist & Barra Subgroup M Munro Organiser Harris Voluntary Council M MacInnes Service User An Caladh M Campbell Member Job Centre Plus ADP Vacant representative requested Licensing Board member Comhairle nan Eilean Siar ADP ADP Lewis & Harris Subgroup ADP Uist & Barra Subgroup In Attendance: Name Designation Organisation Workgroup/ Subgroup D MacKenzie Management Accountant NHS Western Isles Executive Subgroup ADP Support Team: Name Designation Organisation Support of Workgroup/ Subgroup Wendy Ingledew ADP Coordinator NHS Western Isles ADP Executive Subgroup Lewis & Harris Subgroup Uist & Barra Subgroup Suzanne Macaulay ADP Development Officer NHS Western Isles ADP Executive Subgroup Lewis & Harris Subgroup Uist & Barra Subgroup Fiona MacDonald Health Intelligence NHS Western Isles ADP Executive Subgroup Lewis & Harris Subgroup Uist & Barra Subgroup Vacant ADP Administration NHS Western Isles ADP Executive Subgroup Lewis & Harris Subgroup 6

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8 3. Summary of key changes to be achieved The Outer Hebrides ADP strategic priorities take cognisance of the following documents: Delivery Reform Audit Scotland Drugs and Alcohol Service in Scotland (2009) Scottish Government The Road to Recovery (2008) Scottish Government Changing Scotland's Relationship with Alcohol (2008) Tackling Drugs in the Community ( ) HEAT Targets: (HEAT 4 Alcohol Brief Interventions, Heat 11 Drug & Alcohol Waiting Times) Licensing (Scotland) Act 2005 Quality Standards Single Outcome Agreement Early Years and Early Intervention Strategy CnES ( ) Getting it Right for Children in the Outer Hebrides Integrated Children s Services Plan ( ) Western Isles Health & Well Being Strategy i. The Outer Hebrides ADP strategic priorities are further based on links to the following local and national strategies, research and evidence of need. Early Years - Links to strategies and initiatives: Better prevention of substance use problems, with improved life chances for children and young people. (The Road to Recovery, 2008) Children affected by a parental substance misuse problem are safer and more able to achieve their potential (The Road to Recovery, 2008) Supporting families and communities affected by substance misuse (Changing Scotland s Relationship with Alcohol, 2009) Early Interventions - Links to strategies and initiatives: The purpose of an early intervention approach is to work in partnership to improve outcomes for children, young people, adults and families who are very likely to experience difficulties and to break the intergenerational cycle of problems in the long term (Early Intervention City Programme Briefing) Reduce alcohol consumption (Changing Scotland s Relationship with Alcohol, 2009) Intervene as early as possible to tackle problems that have already emerged for children and young people early intervention can help children from pregnancy to 18, not only when they are very young. This needs to be factored into the planning and delivery of services and into staff training. (Early Intervention; Securing Good Outcomes for all Children and Young People, 2010) 8

9 Problem Drinkers and Substance Users - Links to strategies and initiatives: Problems due to the harmful health consequences of individual dependency on alcohol and drugs by a minority of people often compounded by a variety of other predating or consequential problems, requiring a sophisticated range of treatment interventions and recovery support. (Approaches to Alcohol and Drugs in Scotland,2008) See more people recover from problem substance misuse (The Road to Recovery,2008) Improve support and treatment for those who need it (Changing Scotland s Relationship with Alcohol,2009) Promoting a Healthy Outer Hebrides: Communities that are safer and stronger places to live and work because crime, disorder and danger related to drug and alcohol use have been reduced (The Road to Recovery, 2008) Improve the effectiveness of delivery at a local level (The Road to Recovery, 2008) Positive public attitudes towards alcohol and individuals better placed to make positive choices about the role of alcohol in their lives (Changing Scotland s Relationship with Alcohol, 2009) Supporting families and communities (Changing Scotland s Relationship with Alcohol, 2009) At the local community level, substance misuse problems vary. The significant differences in levels of damage between communities are associated with other issues, a major one being the distribution of inequality. A key issue in the opinion of many is that, of all areas of investment in addressing substance misuse problems, the community dimension has been the least understood and valued. (Approaches to Alcohol and Drugs in Scotland, 2008) Mental health improvement is being taken forward in the context of the Scottish Government s National Performance Framework. This is supported by action to promote solidarity and cohesion, and Government action in key policy areas such as other health-related policies on alcohol, substance misuse, physical activity and health inequalities and areas such as early years, education, older people, homelessness, poverty and social inclusion. (Towards a Mentally Flourishing Scotland: Policy and Action Plan, 2009) Single Outcome Agreement ( ) (Outer Hebrides Community Planning Partnership) In November 2007 national and local governments signed a concordat, which committed both to moving towards Single Outcome Agreements (SOAs) for all 32 of Scotland's councils and extending these to Community Planning Partnerships (CPPs). The Scottish Government and local government share an ambition to see Scotland's public services working together with private and voluntary sector partners, to improve the quality of life and opportunities in life for people across Scotland. Single Outcome Agreements are an important part of this drive towards better outcomes. They are agreements between the Scottish Government and CPPs which set out how each will work towards improving outcomes for the local people in a way that reflects local circumstances and priorities, within the context of the Government's National Outcomes and Purpose which is To focus Government and public services on creating a more successful country, with opportunities for all of Scotland to flourish, through increasing sustainable economic growth." Fifteen National Outcomes describe what the Government wants to achieve over the next ten years. 9

10 The National Outcomes most relevant to substance misuse are: Outcome Number National Outcome 2 National Outcome 4 National Outcome 5 National Outcome 6 National Outcome 7 National Outcome 8 National Outcome 9 National Outcome 11 Title of Outcome We realise our full economic potential with more and better employment opportunities for our people. Our young people are successful learners, confident individuals, effective contributors and responsible citizens. Our children have the best start in life and are ready to succeed. We live longer, healthier lives. We have tackled the significant inequalities in Scottish society. We have improved the life chances for children, young people and families at risk. We live our lives safe from crime, disorder and danger. We have strong, resilient and supportive communities where people take responsibility for their own actions and how they affect others. The SOA sets out the outcomes each authority wishes to achieve, working with its Community Planning Partners. Each SOA should identify local outcomes and express specific local priorities and which should inform one or more national outcomes. SOAs will be explicitly negotiated and agreed with Community Planning Partnership. Within the Outer Hebrides SOA, there are high level outcomes on substance misuse, which must be monitored and reported on. These are highlighted below: National Outcome Local Outcome Local Indicator 6, 7, 8, 9 The physical and mental health and wellbeing of the people throughout the Outer Hebrides is improved. Alcohol related discharges standardised per 100,000 population. (Source: ISD SMR01, quarterly WI NHS Annual) Rate of drunkenness offences recorded per 10,000 population. (Source: Annual/SG Recorded offences DA31A ) 10

11 ii. HEAT Targets and HEAT Standards ( ) Each year the Scottish Government agrees a suite of national NHS performance targets known as HEAT targets. NHS Boards and the Scottish Government monitor Boards' performance against the national HEAT targets and progress is published on the Scottish Government's Scotland Performs website. The HEAT targets reflect the agreed areas for specific accelerated improvement each year. NHS Boards are required to submit Local Delivery Plans to the Scottish Government outlining how they will attain national quality standards and HEAT targets. Local Delivery Plans are the 'performance contract' between Scottish Government and NHS Boards, based on the key ministerial targets and standards. The key health priority areas of NHS Scotland, and the Scottish Government, are as follows: Health Improvement for the people of Scotland - improving life expectancy and healthy life expectancy; Efficiency and Governance Improvements - continually improve the efficiency and effectiveness of the NHS; Access to Services - recognising patients' need for quicker and easier use of NHS services; and Treatment Appropriate to Individuals - ensure patients receive high quality services that meet their needs. These targets and standards will be used as performance measures whereby NHS Boards are held to account for their achievement of agreed priority targets. The targets and standards relating to alcohol services, included within HEAT are: H4: Alcohol Brief Interventions, using the setting-appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines to be delivered by Primary Care staff, A&E staff and also maternity units. A target of 338 alcohol brief interventions by 2013 has been set for NHS Western Isles, 90% within primary care and 10% within the wider setting. A11: Clients will wait no longer than 3 weeks from referral received to appropriate drug treatment that supports their recovery. HEAT targets will ensure that the quality and availability of alcohol and drug services will feature more prominently in the future in the wider NHS performance. iii. National ADP Core Outcomes To assist ADPs in demonstrating progress, a set of seven core outcomes has been developed by the Scottish Government. Core Outcomes are intended to sit alongside and not replace ADP Specific Outcomes which reflect local needs assessments and strategies, as well as those outcomes contained in Single Outcomes Agreements in Community Planning Partnerships. Progress towards all seven of these core outcomes, as well as locally specific outcomes will provide a rich local and national account of progress led by ADPs across the country. 11

12 Agreed National ADP Core Outcomes: 1. Health: People are healthier and experience fewer risks as a result of alcohol and drug use: A range of improvements to physical and mental health, as well wider well-being, should be experienced by individuals and communities where harmful drug and alcohol use is being reduced, including fewer acute and long-term risks to physical and mental health, and a reduced risk of drug or alcohol-related mortality. 2. Prevalence: Fewer adults and children are drinking or using drugs at levels or patterns that are damaging to themselves or others: A reduction in the prevalence of harmful levels of drug and alcohol use as a result of prevention, changing social attitudes, and recovery is a vital intermediate outcome in delivering improved long-term health, social and economic outcomes. Reducing the number of young people misusing alcohol and drugs will also reduce health risks, improve life chances and may reduce the likelihood of individuals developing problematic use in the future. 3. Recovery: Individuals are improving their health, well-being and life-chances by recovering from problematic drug and alcohol use: A range of health, psychological, social and economic improvements in well-being should be experienced by individuals who are recovering from problematic drug and alcohol use, including reduced consumption, fewer co-occurring health issues, improved family relationships and parenting skills, stable housing, participation in education and employment and involvement in social and community activities. 4. CAPSM: Children and family members of people misusing alcohol and drugs are safe, well-supported and have improved life-chances: This will include reducing the risks and impact of drug and alcohol misuse on users children and other family members; supporting the social, educational and economic potential of children and other family members; and helping family members support the recovery of their parents, children and significant others. 5. Community Safety: Communities and individuals are safe from alcohol and drug related offending and anti-social behaviour: Reducing alcohol and drug-related offending, re-offending and anti-social behaviour, including violence, acquisitive crime, drug-dealing and driving while intoxicated, will make a positive contribution in ensuring safer, stronger, happier and more resilient communities. 12

13 6. Local Environment: People live in positive, health-promoting local environments where alcohol and drugs are less readily available: Alcohol and drug misuse is less likely to develop and recovery from problematic use is more likely to be successful in strong, resilient communities where healthy lifestyles and wider well-being are promoted, where there are opportunities to participate in meaningful activities and where alcohol and drugs are less readily available. Recovery will not be stigmatised, but supported and championed in the community. 7. Services: Alcohol and drugs services are high quality, continually improving, efficient, evidence-based and responsive, ensuring people move through treatment into sustained recovery: Services should offer timely, sensitive and appropriate support, which meets the needs of different local groups (including those with particular needs according to their age, gender, disability, health, race, ethnicity and sexual orientation) and facilitate their recovery. Services should use local data and evidence to make decisions about service improvement and redesign. 13

14 4. National Core Outcomes i. National core outcomes and indicators to be achieved Outcome Indicator Outer Hebrides Scotland 1. HEALTH People are healthier and experience fewer risks as a result of alcohol and drug use. Rate of drug related hospital discharges (three year rolling average over last 5 years) Rate of alcohol related hospital discharge rates (three year rolling average over last 5 years) Rate of alcohol related mortality (three year rolling average over last 5 years) Outcome Indicator Outer Hebrides Scotland Estimated prevalence of Problem Drug Use Amongst year olds in Scotland, by age group. 2007/10: 28 per 100,000 pop 2007/10: 1,025 per 100,000 pop 2008/10: 24 per 100,000 pop 2009/10: 0.8% 2007/10: 116 per 100,000 pop 2007/10: 742 per 100,000 pop 2008/10: 22 per 100,000 pop Prevalence of hepatitis C among injecting drug users 2008/09: /09: 53.5% 2009/10: 1.7% Estimated prevalence of injecting drug use amongst year olds in Scotland. Not published yet Not published yet 2. PREVALENCE Percentage of 15 year olds pupils who usually take illicit drugs at least once a month. 2010: 5.7% 2010: 11.4% Fewer adults and children are drinking or using drugs at levels or patterns that are damaging to themselves or others. Percentage of 15 year olds pupils who usually take illicit drugs at least once a year. 2010: 11.9% 2003 (combined with Orkney and Shetland): 2010: 18.5% 2003: Exceeded daily Exceeded daily The proportion of individuals drinking above daily and/or weekly recommended limits recommended limits: 56.7% recommended limits: 63.5% Exceeded weekly recommended limits: 17.9% Exceeded weekly recommended limits: 28.5% 14

15 The proportion of individuals drinking above twice daily ( binge drinking) recommended limits The proportion of individuals who are alcohol dependent Proportion of 15 year olds drinking on a weekly basis (and their mean weekly level of consumption) 2003 (combined with Orkney and Shetland): Exceeded twice daily recommended limits: 28.8% 2003 (combined with Orkney and Shetland): 14.1% 2010: 14.5% Mean weekly level of consumption: 19 units 2003: Exceeded twice daily recommended limits: 36.7% 2003: 9.4% 2010: 20.4% Mean weekly level of consumption: 19.5 units Outcome Indicator Outer Hebrides Scotland Percentage reduction in daily drugs spend during treatment 3. RECOVERY Individuals are improving their health, well-being and lifechances by recovering from problematic drug and alcohol use. Reduction in the percentage of clients injecting in the last month during treatment Proportion of clients who abstain from illicit drugs between initial assessment and 12 week follow-up Proportion of clients receiving drug treatment experiencing improvements in employment/education profile during treatment. 15

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17 Outcome Indicator Outer Hebrides Scotland 2007/08 09/10: 4. CAPSM Children and family members of people misusing alcohol and drugs are safe, well-supported and have improved life-chances. Rate of maternities recording drug use (three year rolling average) 2007/ /10: * 11.9 per 1,000 maternities Rate of maternities recording alcohol use Not published yet Not published yet Number of Child Protection Case Conferences where parental drug and alcohol abuse has been identified as a concern/risk Proportion of positive ABI screenings in ante-natal setting 2011/12: 0 Outcome Indicator Outer Hebrides Scotland Percentage of new clients at specialist drug treatment services who report funding their drug use through crime 2010/11: * 2010/11: 21.6% 5. COMMUNITY SAFETY Communities and individuals live their lives safe from alcohol and drug related offending and anti-social behaviour. Percentage of offenders given a DTTO who are reconvicted within one year 2008/09: * 2008/09: Number of cases of vandalism (or malicious mischief), breach of the peace, assault or anti-social behaviour Number of Community Payback Orders issued where alcohol and drug treatment is required, and proportion that are successfully completed Proportion of victims of a crime who reported that the offender was under the influence of alcohol/drugs 2010/11: 21.7 per 1,000 pop Northern Constabulary 2010/11: Alcohol - 28% Drugs 15% 2010/11: 35.5 per 1,000 pop 2010/11: Alcohol 22% Drugs 13% Outcome Indicator Outer Hebrides Scotland 6. LOCAL ENVIRONMENT People live in positive, healthpromoting local environments where alcohol and drugs are less readily available. Percentage of young people who have been offered drugs in the last year Percentage of people perceiving drug misuse or dealing to be common or very common in their neighbourhood. Percentage of people noting alcohol abuse as a negative aspect of their neighbourhood 2010: 65.4% 2010: 57.5% 2009/10: 2.2% 2009/10: 11.6% 2009/10: 2% 2009/10: 4% = 17

18 Number of premise and occasional licences in force per annum and the overall capacity of premise licences. Number of new applications for premise or occasional licences, and proportion refused on the grounds of overprovision. Not yet available Not yet available Not yet available Not yet available Outcome Indicator Outer Hebrides Scotland 7. SERVICES Alcohol and drugs services are high quality, continually improving, efficient, evidencebased and responsive, ensuring people move through treatment into sustained recovery. The number of screenings (using a validated screening tool) for alcohol use disorders delivered and the percentage screening positive with the breakdown of i) % eligible for ABI and ii) % eligible for referral to treatment services The number of alcohol brief interventions delivered in accordance with the HEAT standard guidance Percentage of clients waiting more than three weeks between referral to a specialist drug and alcohol service and commencement of treatment. Number of treatments drug service clients receive at 3 month and 12 month follow-up (and annually after that) 2010/11: /11: 88,138 December 2011: 0% December 2011: 15.1% ii. Single outcome agreement alcohol outcome and indicators Outcome Indicator Outer Hebrides Target Charges brought for offences directly attributable to alcohol 2009/10: 159 Decrease Reducing the harmful affects of alcohol Alcohol related general hospital discharge rate 2010/11: 1,0154 per 100,000 pop Decrease to meet Scottish average Annual rate of defined daily dose per capita of antidepressants 2011/12: Decrease Percentage of people reporting 'alcohol misuse' as a concern 2010/11: 58% Decrease Reported alcohol related fires 2011/12: 1.9 per 100,000 pop Decrease Percentage of health screening female attendees reporting above the weekly recommended limits 2011/12: 7% = Decrease Percentage of health screening male attendees reporting above the weekly recommended limits 2011/12: 17% Decrease 18

19 5. Local Outcomes i. Local core outcomes and indicators to be achieved Outcome Indicator April 11 October 11 September 11 March HEALTH Experienced an improvement in physical health People are healthier and experience fewer risks as a result of alcohol and drug use. Experienced an improvement in mental health Experienced an improvement in co-occurring health issues Outcome Indicator April 11 September 11 October 11 March PREVALENCE Are alcohol dependent Fewer adults and children are drinking or using drugs at levels or patterns that are damaging to themselves or others. Are currently stable Are intravenous drug users 0 0 Have reduced their risk-taking behaviour Outcome Indicator April 11 September 11 October 11 March 12 Are unemployed RECOVERY Individuals are improving their health, well-being and life-chances by recovering from problematic drug and alcohol use. Are in employment Are in education/training Experienced an improvement in employability status Experienced an improvement in educational attainment Have moved into employment 21 9 Have moved into education/training Have achieved qualifications in this period Increased knowledge of the consequences and risks of alcohol and drugs Are in settled housing Are in temporary accommodation Are homeless 17 1 An improved ability to sustain a tenancy

20 Improved independent living skills Improved personal relationships Feel involved in their local community Increased ability to make positive choices Increased confidence and self-esteem Improved ability to maintain their finances Improved school/college/training attendance rates Outcome Indicator April 11 September 11 October 11 March 12 Improved their parenting skills CAPSM Children and family members of people misusing alcohol and drugs are safe, well-supported and have improved lifechances. Providing an improved supportive environment for children Participating in family activities Experiencing improved protection of children Children affected by substance misuse with improved school attendance rates 59 8 Children affected by substance misuse with improved school attainment Children affected by substance misuse with improved self-confidence and resilience skills Increased number of children having positive relationship with parents Improved accommodation profile for SU with children living with them 11 4 Improved illicit drug/alcohol profile for SU with children living with them Increased understanding of the impact of substance use has on carers/family members/children Outcome Indicator April 11 September 11 October 11 March COMMUNITY SAFETY Report funding their drug use through crime 5 1 Communities and individuals live their lives safe from alcohol and drug related Are on a DTTO/probation offending and anti-social behaviour

21 Outcome Indicator April 11 September 11 October 11 March 12 New referrals received SERVICES Alcohol and drugs services are high quality, continually improving, efficient, evidence-based and responsive, ensuring people move through treatment into sustained recovery. Returning referrals Referrals to other agencies Discharges from the service Unplanned discharges from the service Initial care plans agreed Have an individual focused care plan Care plans reviewed Care plans completed

22 6. Financial Investment Outer Hebrides ADP Funding ALLOCATION: CHECK Alcohol Allocation 541, , Drug Treatment Services and Support (DTS/HH/DMP) 161, , Sub Total ADP Funding paid to NHS Western Isles 703, EXPENDITURE: Outer Hebrides ADP 703, , Committed Expenditure - Essential Services: ADP Support Officers 105, , , Travel and Subsistence 4, , , Partner Service Delivery SMC U&B 42, , , Public Information, Campaigns, Projects 4, , , , NHS (BI's: Alcohol Liaison Nurse, Well North, Data Collection 130, , , Allocation paid to services March to June , , , Sub Total , , , Allocation Allocation paid to services Uist & Barra July to September , , , Hebrides Alpha Supported Accommodation 33, , , CNES - Community Education - Outreach 27, , , Action For Children-Support for Children & Families 24, , , CnES - Alcohol Support Worker 23, , , , , , , CnES - Drug Support Worker 23, , , WI NHS Community Detox 32, , , WI NHS-Children & Families Mental Health Support 29, , , WI NHS - Uist & Barra Services 87, , , Hebrides Alpha Trading 23, , , Subtotals 317, , , , Totals 687, , , , Balance 15, , , ,

23 Contributions from Partner Agencies: Although unable to acquire a detailed breakdown of financial or in-kind spend from its partner agencies, there is recognition that partners are able to contribute to alcohol/drugs support for local activities, such as prevention, medications, acute care, etc.; however, the amount of any such support is not specified. 23

24 7. Priority Actions & Interventions to Improve Outcomes i. Priority actions Cognisance has been taken of the following documents: Changing Scotland s Relationship with Alcohol: A Framework for Action, March 2009 The Road to Recovery: A New Approach to Tackling Scotland's Drug Problem, May 2008 Health Scotland Alcohol Logic Model Quality Alcohol Treatment & Support report, March 2011 Supporting the development of Scotland s Alcohol and Drug Workforce, December 2010 We will work with partner agencies to assess the strength of partnership arrangements as outlined in Audit Scotland s Drug and Alcohol services in Scotland Appendix 4: Self Assessment Check list for Partners. This work will start with the partner agencies within the ADP. In line with the Alcohol and Drugs Workforce Statement we will: Promote the agreed national learning priorities for development of the drug and alcohol misuse workforce; Continue our development work in assessing and articulating local workforce development needs aligned with national learning priorities; Encourage and enable multi-disciplinary and multi sector training in generic competences to develop a shared vocabulary and understanding of alcohol and drug problems. This work which has already started within the ADP funded agencies will continue and be rolled out across wider partner agencies. Priority Actions Lead Time Line Early Years Development of services for early years Consider recommendations within CAPSM paper Multi agency training to help identify children at risk at an early stage including those within specialist alcohol and drug services ADP CPP CPP ADP ongoing Early Intervention Alcohol Brief Interventions: Continue embedding of Brief Implementation of new FAST scoring sheet to ensure better reporting from acute and wider settings ADP SMIRO September

25 Interventions within NHS Western Isles Acute Sector & roll out of Brief Interventions for young people both statutory and voluntary sector Improving access to Treatment: 90% of clients will receive treatment that supports recovery within 3 weeks of referral Training for statutory and voluntary services on BI s for young people Ongoing training for NHS staff throughout the Outer Hebrides Implementation of monthly reports to services regarding ongoing waits ADP & NHS trainers August 12 March 13 SMIRO August 2012 ongoing Providing support for Young People, Children & Families Affected by Substance Misuse Problem drinkers and Substance Users Delivering Recovery Orientated Systems of Care We will continue to support and monitor Action For Children in the delivery of services for Early intervention with children and families affected by substance misuse Service Development Meet with Uist and Barra service Providers to agree areas for development as per delivery plan Development of service and protocols, etc ADP August 2012 ongoing SMC U&B & ADP SMC U&B July September 12 Governance We will provide all funded services with new SLAs We will develop monitoring of service delivery against national and local outcomes accordingly Enhance multiagency working via training support and practice development Promoting a Healthy Outer Hebrides Community safety Publicity campaigns with partners to promote sensible drinking message, anti drink driving and drug information ADP ADP ADP ADP/ Community Safety September December 12 July 12 September July 2012 March 2013 Ongoing September 2012 December

26 Secretariat/Governance ADP Promote Outer Hebrides ADP website to ensure that all agencies, individuals, etc. have access information on services available within the geographical area and nationally To carry out self assessment check from Audit Scotland s self Assessment checklist Partnership/ Northern Constabulary ADP Ongoing Jan March 2012 To develop outcomes database, monitoring forms, local indicators and indicators from baseline figures in order to continuously improve our monitoring and evaluation ADP September 2012 March 2013 and ongoing until

27 7.2 Investment While deciding on future direction and funding allocations for , the Outer Hebrides ADP considered the points above along with local information from recent community consultations, needs assessments and strategic priorities in order to ensure local needs will be met effectively. In order to allocate funding for , funding was advertised widely across the local press, partner and ADP websites and through local networks. ADP subgroup meetings were held in order to update all local substance agencies on the funding procedures. Applicants were informed that the Outer Hebrides ADP is committed to providing accessible and integrated substance use services throughout the islands and were encouraged to link in partnership with other local agencies in order to submit joint funding bids in order to provide integrated services and equity of access for service users including out of hours services, wherever possible across the Outer Hebrides. Applicants were asked to demonstrate how they would deliver effective services, which included incorporating a client centred, recovery based approach; how the organisation will engage, assess and support clients; the capacity of the organization and details of organisational and staff experience and qualifications. Applicants were also asked to demonstrate how to evidence and how they will gather, collate and report on meaningful outcomes. Following the funding allocation meeting, funding was allocated to the services listed in the section below. It was recognised that the services funded in will be a transition year. Four statutory services have been funded for but have been advised that the Scottish Government funding allocation to ADPs for the period is only indicative at this point and is subject to parliamentary approval but that should this approval be given, it has been agreed by the ADP that funding will be reduced by 50% in and reduced by 100% thereafter meaning no further funding will be available in This is due to these services having been funded for a number of years and the need to free up funding in to allow the ADP to develop services within the priority areas of early years and early intervention. Investment has been directed to services to meet following strategic priorities: Early years and early intervention: We will provide services so that children, young people and families affected by alcohol and/or drug problems are offered the right kind of help to ensure we are Getting It Right For Every Child. We have prioritised early intervention and prevention, including diversionary activities which will encourage children and young people away from substance misuse problems. Problem drinkers and substance users: The Scottish Government have highlighted that a key role for Alcohol and Drug Partnerships is to ensure that the ring fenced funding available to them is used to support the development and provision of recovery-oriented systems of care. The factors that impact on an individual s ability to achieve recovery are many and complex, and will include wider economic and 27

28 social trends. However, there are a number of key factors which, if effectively addressed, should lead to an improvement in their overall quality of life. In preparation to meet the HEAT 11 Target for 2013 (90% of clients will receive treatment that supports recovery within 3 weeks of referral) we have developed Local Improvement Targets which will be submitted quarterly by all services and collated by the Substance Misuse Information & Research Officer. This Local Improvement Target will also be built into our Service Level Agreements with local treatment providers. Members of the ADP Executive Subgroup will review all ADP funded services annually. Information from annual reports, HEAT, local improvement targets and workforce development plans will be used to inform these reviews. Assist in the Promotion of a Healthy Outer Hebrides: In conjunction with the Community Safety Partnership we will continue support of campaigns which feature a variety of initiatives designed to promote positive attitudes and choices. We will involve service users and wider community members in local activities such as Alcohol Awareness Week, and local community events. We will develop our website and provide publications with clear and credible information about our local services and ensure these are available throughout the Outer Hebrides. To achieve the above we will provide services to: Support the Community Planning Partnership to achieve its long term outcomes of communities becoming safer and healthier by reducing the numbers of young people who suffer from the harmful effects of alcohol and substance misuse. 28

29 7.3 Distribution of resources i. Tier 1: Alcohol Brief Interventions across the Outer Hebrides: 130,000 allocated During the Heat Target has become a HEAT standard and the Outer Hebrides has a target of 338 to deliver on with 90% of these in Primary Care and 10% in the wider setting. Alcohol Liaison Nurse We will continue to fund the Alcohol Liaison Nurse as directed by the Scottish Government in order to address the challenge of delivering training and embedding the routine screening and delivery of ABIs into clinical practice throughout NHS Western Isles. We will continue to embed ABIs into routine clinical practice as well as the wider community setting through services such as CAMHS and Community Education youth work services. Primary Care: GPs Nine (9) out of the 10 GP Practices in the Outer Hebrides are currently participating in the Enhanced Service for the delivery of ABIs within their Practice. Practices forward details of the patient CHI number, FAST score and whether or not an ABI was delivered to the Primary Care Manager on a quarterly basis. This information is in paper format but available for validation. Primary Care: Well North Well North has shown consistent achievement of the delivery of ABIs within the Primary Care setting, with all attendees at the clinic offered a FAST screening and/or a brief intervention as appropriate. The data is recorded within the dedicated Well North Excelicare database which Public Health Intelligence can enter directly to extract the data required relative to the H4 target. Well North data includes FAST screening scores and consumption data but does not record information regarding referral to other services. PHI extracts the data from the Excelicare system on a monthly basis. Accident & Emergency A&E has also shown continuous achievement with the ABI delivery and recording system put in place within the department. The data is recorded on a basic template via a paper form which is then transferred onto the PC and ed to PHI (previously posted). The template includes; Date of screen CHI number FAST screening score Weekly units consumed ABI given Referrals From these 6 questions we can get a clear idea of the appropriate delivery of any interventions carried out. A&E does not record consumption levels, which in addition to the FAST screening score can also indicate whether delivery of an intervention was appropriate. Other data such as CHI number or referral information can also at times be incomplete. The remainder of the data, 29

30 however, is recorded at a reasonable level and a fair picture of activity is generally achievable. A&E submits ABI delivery figures to PHI on a monthly basis. Antenatal In the Outer Hebrides, there have been no ABIs delivered in the antenatal setting to date. This is partly due to a lack of training in this area but can also be attributed to the small numbers of women attending in the Outer Hebrides, thus resulting in few presentations where an ABI is deemed appropriate. There are currently 5 antenatal staff trained in the delivery of ABIs in the Outer Hebrides. Development work We must be aware that healthcare settings should not detract from the original motive of presentation by becoming too focused on ABI standards. It is also important that, if the recording of such events is to be carried out, it is done in a proper manner that is useful to its purpose, particularly where monies are being paid out in order to ensure the correct assembly of data is achieved. It is the intention of the ABI Planning Group that a universal reporting system is employed within all healthcare settings with the aim of gathering as much information as possible during the delivery of an ABI but without imposing too much of a disturbance to the daily running of any healthcare facility. A proposal for a new recording template, which allows for greater inclusion of the core data set initially requested by the Scottish Government, has thus been introduced to the ABI Planning Group and is awaiting approval. In order that the new template is successful within all departments there must be a short period of adjustment where the new template is agreed and distributed to all healthcare settings involved. In addition, a new LES agreement for GPs has been agreed, where a compromise was established as to what is a reasonable level of detail for GPs to report in order to both comply with Scottish Government targets yet also ensure efficient use of the practitioner s time. As an incentive for compliance, it was suggested that the data received from GPs must be validated through the PHI department before any monies are paid in recognition for their work. It has been agreed that brief interventions will be rolled within the wider setting starting with young people and BI delivery is already underway within the CAMHS service. 30

31 ii. Services in Uists and Barra The Outer Hebrides are made of up of Lewis, Harris, the Uists and Barra and Vatersay. These island groups have individual needs and therefore require individual services due to geographic location and local need. The services listed in the section below relate to services funded in Lewis and Harris. The ADP are working with the a range of local services in Uist and Barra to develop a new partnership approach that will see all local substance agencies come together under one partnership organisation to provide a seamless, accessible, needs led, recovery based service. The ADP have set aside a sum of money for this development and delivery of a partnership service through the identification joined up working initiatives between all service providers in Uist and Barra. In substance services in the Uists and Barra will offer: A dedicated addiction team to facilitate and manage the creation and development of the team and provision of Tier 1 3 services to clients A dedicated addiction team to address the rise of alcohol and drug misuse in the community Maintain the provision and development of Treatment, Counselling Support and Aftercare arrangements throughout Uist and Barra Counselling and support to clients with a substance misuse problem Support service users to maintain positive lifestyles that do not revolve around substance misuse Support social interaction with other members of the community in a supportive substance free environment Support individuals caught up in addiction to alcohol or drug and offer the opportunity and reason to turn towards a nondependency lifestyle Support individuals in a safe environment whilst enabling their transition and reintegration into normal community life Support service users to maintain positive lifestyles that do not revolve around substance misuse Support social interaction with other members of the community in a supportive, substance free environment Support families and carers of clients to cope with living with a substance misuser, adjust to changes while clients are in recovery and towards a healthier lifestyle. Reengage with previous service users who have disengaged from regular support services Services offered to clients will be based firmly on evidenced based models of care. Services will also formulate and implement shared policies and procedures based on validated guidelines leading to improvements in their delivery of care. This is a new direction for services in the Outer Hebrides and it will require significant support by the ADP to implement. 31

32 iii. Services in Lewis and Harris The Outer Hebrides ADP has funded the services outlined below to deliver substance services in Lewis and Harris. The Tier 4 Hebrides Alpha Supported Accommodation is the only Tier 4 service in the Outer Hebrides but the service is available to the whole population. Tier 2 5 Services in Lewis and Harris: Tier Service Funding Local Strategic priorities 2 Comhairle Nan Eilean Siar, Community Education Dept: Outreach Project Western Isles National Core Outcomes 27,286 -Early Intervention 1. Health 2. Prevalence 3. Community Safety To provide a service which engages with and supports vulnerable young people by providing diversionary activities and preventative work through 1-1 ABI work, Community Learning and Development youth groups, Street based Outreach services, educational inputs and weekend diversionary activities. 2 Hebrides Alpha Trading CIC 23,523 - Problem drinkers and substance users 1. Health 2. Prevalence 3. Recovery 4. CAPSM 5. Community Safety 6. Local Environment 7. Services Provide 16 hours of therapeutic employment each week to service users. Participate in a range of relevant employment related certificated training. Provide a range of support measures outwith their 16 hours per week. 2 Action for Children: Early Intervention Children & Families 24,449 - Early Years -Early Intervention 1. Health 2. Prevalence 3. Recovery 4. CAPSM 5. Community Safety 32

33 6. Local Environment 7. Services Provide individual based sessions, initially in a 6 week block, which will address substance misuse and any issues associated with this. Provide longer term intervention, up until 6 months, involving young people in diversionary activities and our community based service. We will do this in partnership with Community Education. Within this period we will continue to work with the young person using a person centered approach to address any issues affecting their well being e.g. family issues, education difficulties, problems in the community. Provide parents with parenting strategies. This will enable families to communicate better. Use Family Group conferencing to address underlying issues. Provide a link for the young person with other agencies, to advocate on their behalf if required. Provide a follow up meeting with the young person and their family 3 months after the end of service to ensure progress continues. 3. Child and Adolescent Mental Health Service Addiction Service 29,008 - Early Years - Early Intervention 1. Health 2. Prevalence 3. Recovery 4. CAPSM 5. Community Safety 6. Local Environment 7. Services Better prevention of substance use problems with improved life chances for children and young people Children affected by parental substance misuse problems are safer and more able to achieve their potential Support families and communities affected by substance misuse Provide and improve on alcohol and substance misuse screening for children, young people and their families Provide assessment of whole family systems to identify vulnerable children and young people that are affected and influenced by parental alcohol and substance misuse Provide early intervention for assessment and treatment of young people with harmful and persistent substance misuse behaviours To provide a consistent approach for Alcohol Brief Interventions (ABIs) for young people across the Outer Hebrirdes 3. Community Nurse (Alcohol Misuse) 32,991 - Early Years - Problem drinkers and substance users 1. Health 2. Prevalence 3. Recovery 4. CAPSM 5. Community Safety 6. Local Environment 7. Services To meet needs of clients who have alcohol misuse issues by multi agency working in partnership with primary health care, Crossreach and Social Work as well as the voluntary sector as required within Lewis and Harris. 33

34 To reduce and prevent hospital admission of those with alcohol dependence by providing support to individuals, families and carers. To continue to strengthen the Integrated Care system using referral pathways and meeting the clinical needs of individuals. 3. CNES Substance Misuse Service Alcohol Support Worker Drug Support Worker 23,204 23,204 - Early Years - Early Intervention - Problem drinkers and substance users 1. Health 2. Prevalence 3. Recovery 4. CAPSM 5. Community Safety 7. Services To engage with service users who have acute problematic alcohol or drug use in order to improve their health, wellbeing, social circumstances and reduce or prevent further harmful behaviours and offending where relevant. Service users will have regular contact with the alcohol or drug support worker service at an appropriate level to their assessed need and risks. Each service user will complete an initial assessment of need and be involved in their own action plan towards change and recovery. They will have the opportunity to undertake focused work based on established models and approaches and will be provided with continuous feedback on progress in making positive change. Where necessary feedback can be provided to partner agencies in written form. Service users will be provided the opportunity to feedback on the quality of service and contribute to developments for future service delivery. 34

35 8. Governance and financial accountability arrangements The Outer Hebrides ADP has responsibility for directing the use of specific alcohol and drug funding. However, funding recommendations are considered within the ADP substructures, i.e., via the ADP Executive Subgroup. Final recommendations are thereafter submitted to the ADP for ratification. In line with the ongoing development of Outcomes and outcomes measures, further work regarding the establishment of clear and transparent funding structures is ongoing and will be reflected within future Delivery Plans and Annual Reports. The current efficient and effective means of reporting to the Community Planning Partnership (CPP) will be maintained; i.e. the ADP Chair sits on CPP Executive Group and Board, other members of the ADP sit on the Community Safety Planning Partnership, and there are strong links with most, if not all, other groups, i.e., Health and Well Being, etc. Regular reports, using covalent information are fed into the CPP and other relevant groups. Similarly the ADP Alcohol and Drug Strategy and associated progress reports are submitted annually to the CPP. The Outer Hebrides ADP recognise the importance of monitoring and evaluating work and affirms that we will: Continually review the strategy to evaluate progress. Exercise budget exceptional reporting to the Strategic group. Regularly review the gaps in services and respond timely to the local needs. Support evidence-based practice and high quality evaluation. Learn from good practice, evaluations, pilot projects and disseminate learning. Obtain six-monthly and annual accountability reports from services to monitor progress and to identify opportunities for support and development. Each initiative, post or project is managed via a service level agreement with the Outer Hebrides ADP. Funding for each initiative is agreed on the proviso that outcomes for the initiative or project directly relate to the objectives, goals and desired outcomes for the Outer Hebrides ADP. Each initiative will be required to provide evidence of project planning and monitoring of progress through performance and outcome indicators. Regular reports on progress and effectiveness are provided to the Outer Hebrides ADP which will monitor these against the agreed Delivery Plan. NHS Western Isles and the Outer Hebrides ADP are accountable to the Scottish Government for the use of funds allocated to them.

36 9. Request for National Support The ADP benefited from the annual visit from the Drugs Policy Team during and would welcome further visits and support from the team. The continuation of the ADP Chair s meetings for networking and information exchange and the wider events for ADP Chairs and support teams is also seen as being of value, though continued financial assistance to attend these events would be greatly appreciated. We welcome the confirmation that ISD will support the Outer Hebrides ADP in relation to the ongoing monitoring of waiting times and the continuation of data sets and monitoring. We look forward to the production focused Board level reports on specific topics, e.g., alcohol. We would welcome support from the Scottish Government in developing a Commissioning Strategy for the Outer Hebrides. We further welcome ongoing support from STRADA in providing FREE training throughout the Outer Hebrides and the monitoring and evaluation of said training for local training needs analysis. We would request ongoing support from Health Scotland with regards to the delivering of training, resources provided for Alcohol Brief Interventions, and advice on Alcohol Brief Interventions updates. Support re actions in the delivery and implementation of the workforce development statement within the Outer Hebrides is sought. Support re actions in addressing practical issues highlighted in the Audit Scotland Self Assessment Check List for D&A Services, e.g., risks, would also be welcomed. 36

37 Appendix 1: Diagrams to support Delivery Plan i. Outcomes triangle We live longer, healthier We have tackled the significant lives inequalities in Scottish society Outcomes triangle - Alcohol We live our lives free from crime, disorder and danger We realise our full economic potential Our children have the best start in life NATIONAL OUTCOMES Reduced inequalities in HLE, Improved Mental Wellbeing, Reduced alcohol-related deaths & hospital admissions HIGH LEVEL OUTCOMES Less hidden harm to children Increased educational attainment Less work absenteeism & incapacity Reduced alcohol-related ASB & crime Reduced alcohol consumption beyond recommended limits INTERMEDIATE OUTCOMES Supportive environments for children of alcohol-abusing families Sensible drinking culture Access to & affordability of alcohol Safer drinking & wider environments Wealthier & Fairer Smarter Healthier Safer & Stronger Greener Outcomes related to service delivery SHORT-TERM OUTCOMES Diagram from

38 Appendix 1: Diagrams to support Delivery Plan ii. Diagram showing how different levels of outcomes link to achievement of National Outcomes Reduction in substance related morbidity & death Reduced substance use in local area Service users reduce substance use Diagram adapted from Delivering Better Outcomes: An Outcomes Toolkit for Alcohol and Drug Partnerships ; Scottish Government 38

39 Appendix 1: Diagrams to support Delivery Plan iii. Diagrams showing that various outcomes may feed into one or more higher-level outcome, together with examples to illustrate these links. Service-level outcome 1 Service-level outcome 2 Intermediate outcome 1 High-level outcome 1 High-level outcome 2 National outcome 1 National outcome 2 National outcome 3 Increased knowledge Increased enforcement Reduced consumption Improved health Less ASB & disorder Tackled inequalities Healthier longer lives Safer communities Increased knowledge Reduction in chaotic or risky behaviour Reduction in drug use Less drugrelated death Reduced crime Tackled inequalities Healthier, longer lives Safer communities Diagram adapted from Delivering Better Outcomes: An Outcomes Toolkit for Alcohol and Drug Partnerships ; Scottish Government 39

40 Appendix 1: Diagrams to support Delivery Plan iv. How models contribute to improvement of long term alcohol related outcomes in Outer Hebrides Model 1: Model 2: Model 3: Model 4: Model 5: Model 6: Intermediate outcomes Children in need receive timely and appropriate support Increased detection and referral of harmful and dependent drinkers Individuals in need receive timely, sensitive & appropriate support Safer drinking + wider environments Reduced acceptability of hazardous drinking and drunkenness Increased knowledge and changed attitudes to alcohol + drinking Reduced availability of alcohol A culture in which low alcohol consumption is valued and accepted as the norm Reduction in Individual and population consumption Safer drinking patterns Less absenteeism + presenteeism in educational establishments Fewer children affected by parental drinking Less absenteeism + presenteeism the workplace. Less alcohol related incapacity Less alcohol related violence/abuse, offences and ASB Reduced alcohol related injuries, physical and psychological morbidity + mortality Long term outcomes Increased educational attainment Increased workplace productivity Safer & happier families and communities Reduced health, social care, justice costs Healthier individuals and populations National outcomes Reduce significant inequalities Model 7: Reduced affordability of alcohol Fewer children affected by maternal drinking during pregnancy Diagram adapted from 40

41 Appendix 1: Diagrams to support Delivery Plan v. Outer Hebrides Alcohol Drug Partnership Contributions Diagram adapted from 41

42 Appendix 2: Logic Models Model 1: Early Years All Models adapted from 42

43 Appendix 2: Logic Models Model 2: Early Intervention M odel 2: Early Intervention Final Feb 09 Action S hort-term out come Int ermediate outcome Achieve target for delivery of alcohol brief interventions Increased incentive to deliver ABI s in NHS settings increased Increas ed detection and r eferr al of harmful and dependent drinker s Agree LES re delivery of alcohol brief interventions (ABI s) in primary care Increase workforce development re brief interventions Increased number of ABI s delivered in NHS settings Increased quality of ABI s delivered in NHS settings Individuals in need receive timely sensitive and appropriate support dependent on need All Models adapted from 43

44 Appendix 2: Logic Models Model 3: Problem drinkers and substance users Act ion S hort term outcome Programme target for delivery of Alcohol brief interventions (ABI) Increased incentive to deliver ABIs in in NHS settings Investment to reimburse for delivery of alcohol brief interventions (ABI) in primar y care Increased number of quality brief interventions delivered in NHS settings Increased detection and referral of harmful and dependant drinkers Workforce development (brief interventions) Increas ed quality of ABIs in in NHS settings Workforce development (specialist services) Increased capacity and quality of specialist services to meet demand Individuals in need receive timely, sensitive and appropriate support dependant on needs Increased investment in treatment and care services Intermediate outcome Integrated care pathway for offenders Increased access for offenders to a service that meets their need, both in custody and community All Models adapted from 44

45 Appendix 2: Logic Models Model 4: Assist in the promotion of a healthy Outer Hebrides Model 4: Assist in the promotion of a healthy Outer Hebrides Action Support for drunk and incapable adults Reduc tion in dr iving blood alcohol limit and random breath testing Short- term Out comes Fewer incapable intoxic ated drinkers on the streets/in cells Lowered blood alcohol Concentrations in driv ers Inc reased deterrent for detec tion Int ermediat e Outcome Managem ent of night time econom y/safer street initiatives E arly identification and m anagement of potential flas hpoints Reduction in the incidence of drinking and driv ing Im plem entation of and review of overprovision assessm ents No further increase in overpr ovision/super pubs in k ey ar eas B an on price promotions that encourage speed drinking Reduced num ber of ASB/cr im e flashpoints Safer dr inking and wider environm ents Staff training and enfor cem ent of refusal to serv e and aggr ession m anagem ent a Fewer intoxic ated drink ers Wor kplac e alcohol policies Reduction drink ing pre/dur ing work Reduc ed r isk /m is takes in workplace a. May increas e violence in prem ises and/or intoxic ated drinker s on street Italics = SG lobby ing for UK change but remains reserv ed and therefor e not certain 45

46 Appendix 2: Logic Models Model 4.1 : Assist in the promotion of a healthy Outer Hebrides with our partners) Model 4.1: Assist in the promotion of a healthy Outer Hebrides (with our partners) Changing knowledge skills and attitudes Changing knowledge, skills and attitudes Act ion Short-term Outcomes Intermediate Outcomes Restrictions on display of alcohol and promotions Decreased visibility of alcohol Increased acknowledgement alcohol is no ordinary commodity Restrictions on advertising in relation to young people Voluntary code on alcohol sponsorship Tailored public awar eness campaigns Alcohol workplace polices Unit and warning labelling (including pregnancy advice) Dissociation of alcohol with health, glamour, attractive life style and children Increased knowledge re recommended limits and situations where alcohol should be avoided altogether Increased knowledge of consequences/risks of alcohol consumption Increased knowledge of unit content of drinks Decreasing attractiveness of alcohol Increased space for counter messages to get through Increased knowledge and changing attitudes to alcohol and drinking Improved substance misuse education in schools Youth work and diversionary oppor tunities Increased skills within young people to limit alcohol consumption Reduced acceptability of hazardous drinking & drunkenness Staff Training re serving someone who is drunk Increased refusal to serve someone who is drunk Increased refusal to serve someone who is dr unk Italics= SG lobbying for UK change but remains reserved and ther efore not certain 46

47 Appendix 2: Logic Models Model 4.3 : Assist in the promotion of a healthy Outer Hebrides with our partners Reduced affordability Reduced affordabilit y Action Short -term Outcomes Intermediate Outcome End free of charge or reduc ed price alcohol on the purc hase of alcohol or other product No bulk buy disc ounting of alc ohol in on and off sales Prevent the sale of alcohol as a loss leader Inc reases actual and r elativ e pr ice in on and off sales a Reduc ed affordability of alcohol Pr ice of cheapest alcohol inc reased Introduce minim um pr ice based on strength a- may increas e business profits whic h could be put into adv ertising and this m ay encourage more drinking 47

48 Appendix 3: Strategic Models Strategic Model 1.1: Early Years Indicators More children in need receive timely and appropriate support High level outcomes Intermediate outcomes Early Years: Cross-sector Contributions Behaviour Increased number of children living in supportive and stable households Increased participation in community activities Reduction in children's exposure to substance use Reduced number of children looked after and accommodated / separated from parents Safer and happier families Children and family members of people misusing alcohol and drugs are safe, well-supported and have improved lifechances Environments Increased number of children living in supportive, stable and safe environments Improved school/nursery attendance and attainment Increased identification of children affected by parental substance misuse Short-term outcomes Service uptake & engagement Increased levels of participation Improved work force Reduce domestic violence Improved life chances for children Confident able learners Reach Early years, and families Early years and families Early years and families Early years and families Early years and families Early years and families Outputs Activities Inputs Support and Advocacy Services Identification & assessment of those affected by parental substance use NHS Croligeans and play groups Activities for under 5 s Vol orgs Support and advocacy services Training for staff and professionals ADP Child Protection officers Sharing of appropriate information Police Children's services Improve parenting capacity & resilience in children Local authorities Nurseries and child minders Services to support children under 5 in education Education 48

49 Appendix 3: Strategic Model 1.2: Early Intervention 49

50 Appendix 3: Strategic Model 1.3: Problem Drinkers and Substance Users 50

51 Appendix 3: Strategic Model 1.4: Promoting a Healthy Outer Hebrides 51